摘要
目的应用超声技术评价缬沙坦氨氯地平片(商品名:倍博特)对高血压左心室(LV)舒张功能及动脉顺应性的影响。方法选择90例原发性高血压患者分为LV构型异常组(42例)和LV构型正常组(48例),均予缬沙坦氨氯地平片1片(含缬沙坦80 mg,氨氯地平5 mg),po,qd。分别于给药前、给药3和6个月测量血压、脉压和体质量指数,应用超声心动图测定各受试者左房内径(LAD)、左室内径(LVDd及LVDs)、室壁厚度和相对室壁厚度(RWT)、左室质量指数(LVMI)、左室射血分数(LVEF);运用多普勒超声和组织多普勒(TDI)分别记录二尖瓣口的血流频谱(E、A、E/A)和二尖瓣环的运动速度频谱(e'、a'),计算E/e'、e'/a';运用颈总动脉超声检查测左侧颈总动脉内中膜厚度(IMT)、最大径(D_(max))、最小径(D_(min)),计算颈动脉动脉顺应性(AC)、血管僵硬参数(β)和压力应变弹性系数(Ep)。结果原发性高血压LV构型异常组的e'/a'低于LV构型正常组(P<0.05),而E/e'、β、Ep高于LV构型正常组(P<0.05)。给予缬沙坦氨氯地平片治疗3和6个月,与用药前基线值相比,IMT、β、Ep、E/e'降低(P<0.05),AC、e'/a'增高(P<0.05),LV构型正常组干预6个月时恢复至正常值范围。LV构型异常组在干预3个月时左室舒张末期容积、每搏输出量恢复至正常值范围,6个月时LAD、RWT、LVMI恢复至正常值范围,但E/e'、e'/a'、β、Ep与LV构型异常组仍有差别(P<0.05)。结论原发性高血压患者LV舒张功能、动脉弹性的减低,早于动脉结构及心脏构型的改变。缬沙坦氨氯地平片口服3和6个月,对LV构型正常的高血压患者可以改善心脏舒张功能和动脉弹性,对LV构型异常的高血压患者,逆转心脏的重构,形态结构恢复正常,但心脏舒张功能和动脉硬化的参数未完全正常。
AIM To evaluate the impact of amlodipine/valsartan combination on left ventricular （LV） diastolic function and arterial compliance in patients with hypertension by ultrasound imaging. METHODS A total of 90 patients with essential hypertension were divided into abnormal LV geometry group（ n = 42） and normal LV geometry group（ n = 48） .All patients were treated with amlodipine/valsartan combination（valsartan 80 rng / amlodipine 5 mg ）one tablet, po, qd. The blood pressure（BP）, pulse pressure（PP） and body mass index（BMI）were recorded; the left atrium diameter （LAD）, LV diameter （ LVDd, LVDs）, wall thickness and relative wall thickness （RWT）, left ventricular mass index （LV-MI） and left ventricular ejection fraction （LVEF） were measured by echocardiography before and after 3,6 month-therapy respectively. The mitral valve flow pattern（MVFP）（ E, A） and mitral annulus velocity （e＇, a＇） were recorded using Doppler echocardiography and tissue Doppler imaging（TDI）respectively, and the E/e＇ and e＇/a＇were counted. The left common carotid artery （CCA） intima-media thickness （IMT） and carotid diameter （Dmax, and Omin） were measured through carotid echocardiography; the carotid arterial compliance （AC）, vascular stiffness parameters （β）, pressure- strain elasticity modulus （Ep） were calculated. RESULTS Compared with normal LV geometry group, essential hyper- tention with abnormal LV geometry group had lower value of e＇/a＇ （ P 〈 0.05） and higher value of E/e＇, β, Ep （ P 〈 0.05） .After the treatment with amlodipine/valsartan combination for 3 months and 6 months, IMT,β, Ep, E/e＇ were decreased （P 〈 0.05）,while AC, e ＇/a＇ were increased （P 〈 0.05）, and these parameters were normal at 6 months drug therapy in normal LV geometry group（ P 〉 0.05）. LVEDV,SV were normal at 3 months, and LAD, RWT, LVMI were normal at 6 months in abnormal LV geometry group, and the value of E/e＇, e＇/a＇, β, Ep were significantly differ- ent between the abnormal LV geometry group and the control （ P 〈0. 05）. CONCLUSION Decrease in LV diastolic function and arterial compliance of essential hypertension is earlier than change of arterial structure and heart geometry in patients with primary hypertension. Three and 6 month amlodipine/valsartan combination therapy could improve their di- astolic function and arterial compliance in the normal LV geometry group. It could reverse heart remodeling, and normal- ize heart morphology in the abnormal LV geometry group, but it couldn＇t restore the abnormal parameters of diastolic function and arterial stiffness in these patients.
出处
《中国临床药学杂志》
CAS
2013年第6期329-333,共5页
Chinese Journal of Clinical Pharmacy
关键词
缬沙坦氨氯地平
超声
高血压
左心室
颈动脉
amlodipine/valsartan
ultrasound
hypertension
left ventricle
carotid artery
